Rates of Suboptimal Preparation for Colonoscopy Differ Markedly Between Providers: Impact on Adenoma Detection Rates

We sought to determine if providers who have higher standards for optimal bowel preparation might be more fastidious in their examination of the colon and, therefore, have higher adenoma detection rates (ADRs).

ADRs are a reliable and objective marker of colonoscopy performance. Suboptimal bowel preparation impacts upon adenoma detection; however, physicians have varying standards for grading bowel preparation.

Endoscopy reports of patients who underwent screening colonoscopy in 2011 at 1 academic medical center were reviewed. Bowel preparations labeled "fair," "poor," or "unsatisfactory" were considered suboptimal. The ADR was calculated for each endoscopy provider and was correlated with the provider's suboptimal preparation rate. Logistic regression was used to determine independent predictors of adenoma detection.

1649 examinations from 11 separate gastroenterologists were included. Preparation was suboptimal in 22% of examinations overall. The rate of suboptimal preparations varied widely among providers, ranging from 3% to 40%. Overall ADR was 23%, with a range of 13% to 31%. Providers' suboptimal preparation rate was not significantly correlated with ADR (r=-0.22, P=0.51). After adjusting for age and sex, adenoma detection was not associated with provider suboptimal preparation rate (P=0.28).

Rates of suboptimal preparation vary widely between providers, but were not correlated with ADR. This suggests that a high suboptimal preparation rate is not a marker of higher quality standards and expectations by the provider. The impact of physician personality traits on colonoscopy performance requires further study.